Time to revamp Medicaid

As this goes to press, many of the nation's governors are sorting out a major Medicaid decision: Take the money or run.

The “take the money” option is a simpler choice, at least for the short term. Essentially, governors going this route would agree to have most of their Medicaid costs underwritten by the federal government. In exchange, they would agree to expand the pool of people in their state eligible for Medicaid-covered services.

The “run” option seems to be more attractive to governors who fear that the feds may renege on promises to pay, while still insisting on more caregiving requirements. This pick seems to be resonating more with Republican governors.

GOP presidential candidate Mitt Romney has said that repealing the law would be one of his first acts, if elected. That result would presumably make things academic. So there's probably a good reason for governors of both political persuasions to hold their tongues until at least November.

You can't do that, critics shriek. It would be too complicated and costly. Really? Have you taken a look at how well our current two-track program is playing out on those two fronts?

Look, I'm no fan of putting the federal government in charge of anything beyond creating a serviceable military. But we've been experimenting with this Medicare/Medicaid package deal since the mid-1960s. Anyone out there think this approach is working well? Let me clarify: Anyone out there who does not work for a state agency think this is working well?

The current survey and certification system has shown operators how squirrely and unfair things can get when states are put in charge of things that should be above their pay grade. Anyone with properties in more than one state knows exactly what I am talking about. Is a cracked eggshell a deficiency? Depends on the state, how well the state has trained the surveyor, and what kind of mood the surveyor happens to be in that day.

The choice here is quite simple. We can improve a program that is broken, inefficient and unfair. Or we can do nothing and hope.

About 60,000 elderly or disabled Medicaid recipients in Louisiana are being told they should expect to lose their benefits in July, and advocates say more than a quarter of them could be forced out of the long-term care facilities they call home.